ES2669522T3 - Elbow prostheses - Google Patents

Abstract

A prosthesis for elbows (100) comprising: a humeral component (102) comprising a humeral stem (118) and a fork (122) having a first and second ears (124, 126) extending from a base ( 128) of the fork (122); a humeral bearing (106) positionable at the base (128) of the fork (122): a cubital component (104) comprising a cubital rod (130) and a cubital head (132); a first ulnar bearing (108) positionable between the first ear (124) of the fork (122) and the ulnar head (132); a second ulnar bearing (110) positionable between the second ear (126) of the fork (122) and the ulnar head (132); a pin (116) having a first end portion (176) and a second end portion (178) and is configured to extend through the ulnar head (132), the first ulnar bearing (108) and the second bearing cubital (110), wherein the first end portion (176) of the pin (116) is configured to extend into the first ear (124) of the fork (122) and the second end portion (178) of the pin (116) ) is configured to extend into the second ear (126) of the fork (122), and where the ulnar component (104) is configured to rotate around the pin (116) to allow movement of the ulnar components (104) configured to rotate around the pin (116) to allow movement of the ulnar component (104) relative to the humeral component (102): a first fastener (112) that is inserted through at least a portion of the first ear (124 ) of the fork (122) for coupling with the first portion of extr emo (176) of the pin (116); and a second fastener (114) that is inserted through at least a portion of the second ear (126) of the fork (122) to engage with the second end portion (178) of the pin (116).

Description

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DESCRIPTION

Elbow prostheses.

Priority claim.

The priority benefit of the US patent application with serial number 13 / 800,567 of Wagner et al., Entitled "PROSTHESIS FOR CODOS", filed on March 13, 2013; and of the provisional US patent application with serial number 61 / 663,452 by Wagner et al., entitled "MODULAR PROSTHESIS FOR CODOS", filed on June 22, 2012.

Technical field

The present patent application relates to an orthopedic prosthesis and, more particularly, to an apparatus and methods for an elbow prosthesis.

Background

A joint arthroplasty procedure can be performed to repair or replace a damaged bone in a patient's joint, such as a bone that is damaged due to traumatic damage or degenerative diseases. For example, during a joint arthroplasty procedure, the surgeon implants a prosthetic humeral component at the distal end of a patient's humerus and a prosthetic ulnar component at the proximal end of a patient's ulna. The prosthetic humeral component and the prosthetic ulnar component are generally articulated by a hinge that allows the rotating movement between the prosthetic humeral component and the prosthetic ulnar component, to recreate the natural anatomical joint of the elbow joint. US 2006/173546, US 2010/222887, US 2003/144739, US 2011/153024, and WO 2011/060430 describe examples of elbow prostheses that have a modular design and include articulated humeral and ulnar components.

General description

The present inventors recognize, among other things, an opportunity for an elbow prosthesis that allows an articulation of an ulnar component in relation to a humeral component, while minimizing the movement of the support components of the elbow prostheses, including bearing and fastener components used to secure the components of the elbow prosthesis. The elbow prosthesis described herein can be used, for example, in a total primary elbow arthroplastic procedure or in a revision procedure.

Brief description of the drawings

In the drawings, which are not necessarily drawn to scale; The same numbers can describe similar components in different points of view. The same numbers that have different suffixes can represent different instances of similar components. The drawings generally illustrate, by way of example, but not limited to, several modalities described herein.

Figure 1 is a perspective view of an example of an elbow prosthesis in accordance with the present patent application.

Figure 2 is a perspective view of an elbow prosthesis of Figure 1, rotated approximately 180 degrees. Figure 3 is an exploded perspective view of an elbow prosthesis of Figure 2.

Figure 4A is a front view of a humeral component of the elbow prosthesis in accordance with the present patent application.

Figure 4B is a side view of the humeral component of Figure 4A.

Figure 4C is a rear view of the humeral component of Figure 4A.

Figures 4D and 4E are perspective views of a fork of the humeral component of Figure 4A.

Figure 5 is a perspective view of a brace of the elbow prosthesis in accordance with the present patent application.

Figure 6 is a perspective view of a pin of the elbow prosthesis in accordance with the present patent application.

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Figure 7 is a perspective view of a humeral bearing of an elbow prosthesis in accordance with the present patent application.

Figures 8A and 8B are perspective views of a cubital bearing of the elbow prosthesis in accordance with the present patent application.

Figure 9 is a perspective view of an elbow prosthesis of Figures 1-3 in a partially assembled state.

Figure 10A is a side view of a portion of the elbow prosthesis of Figure 9 in an assembled state.

Figure 10B is a perspective view of a portion of the elbow prosthesis of Figure 10A with a fork portion of the partially cut humeral component.

Figure 10C is a cross-sectional view of a portion of the elbow prosthesis of Figure 10A.

Figure 10D is an end view of the portion of the elbow prosthesis of Figure 10B.

Figure 11 is a cross-sectional view of a portion of the humeral component and the humeral bearing of the elbow prosthesis before coupling the humeral bearing to the humeral component.

Figure 12 is a cross-sectional view showing the humeral bearing coupled to the humeral component.

Figure 13A is a perspective view of a portion of the elbow prosthesis in an assembled state.

Figure 13B is a cross-sectional view of a portion of the elbow prosthesis of Figure 13A.

Figure 14 illustrates a method for repairing a patient's elbow joint by using a prosthetic elbow according to the present patent application.

Detailed description

The present application refers to the devices and methods for a prosthesis for elbows that can be used in an elbow arthroplasty procedure. Figure 1 shows an example of an elbow prosthesis 100 that can include a humeral component 102 and an ulnar component 104. The elbow prosthesis 100, as shown in Figure 1, is anatomically oriented (i.e., as the prosthesis for elbows 100 would be oriented if implanted in the body of a patient) and a cubital component 104 is at an angle of approximately forty-five degrees (45), relative to the humeral component 102. The humeral component 102 can be partially received within a channel of the humeral medulla, and the ulnar component 104 can be partially received within an ulnar medullary canal. As will be described in greater detail below, the elbow prosthesis 100 may include suitable connection means that may allow the rotational movement of the ulnar component 104 relative to the humeral component 102.

Figure 2 shows the elbow prosthesis 100 rotated approximately 180 degrees relative to what is shown in Figure 1. The elbow prosthesis 100 may include the humeral component 102, the ulnar component 104, a humeral bearing 106, a first bearing ulnar 108, a second ulnar bearing 110, a first fastener 112, a second fastener 114, and a pin 116. Each of these components are further shown in Figure 3, which is an exploded view of the elbow prosthesis 100 that is shown in Figure 2.

With reference to Figure 3, the humeral component 102 may include a humeral stem 118, a flange 120 and a fork 122 extending from the humeral stem 118. The fork 122 may include a first ear 124 and a second ear 126. The humeral bearing 106 can be located on or coupled to the base 128 of the fork 122.

The ulnar component 104 may include an ulnar stem 130, an ulnar head 132 having an opening or hole 134 extending through the ulnar head 132, and an ulnar neck 131 between the head 132 and the rod 130. The ulnar head 132 can also be referred to as an ulnar eye.

Each of the first 108 and the second 110 ulnar bearings may extend into the opening 134 of the ulnar head 132. The pin 116 may extend through the first ulnar bearing 108, the ulnar head 132, and the second ulnar bearing 110. opposite portions of pin end 116 may extend into the first 124 and second 126 ears of the fork 122 of the humeral component 102. When the humeral component 102 is assembled, the pin 116 may define an axis on which the ulnar component 104 can rotate relative to the humeral component 102.

The first fastener 112 may extend into the first ear 124 of the fork 122 and the second fastener 114 may extend into the second ear 126 of the fork 122 to secure each other to the

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humeral components 102 and ulnar 104. In one example, the first 112 and the second 114 fasteners may have a first thyme and a second thyme, respectively. The coupling between the first fastener 112, the first ear 124 and the pin 116, as well as a similar coupling between the second fastener 114, the second ear 126 and the pin 116, are described in greater detail below.

When the humeral component 102 and the ulnar component 104 are respectively implanted within a humerus or ulna of a patient, the fork 122 of the humeral component 102 and the ulnar head 132 of the ulnar component 104 may remain exposed. The ulnar head 132 may be configured to rotate around the pin 116 to allow movement of the ulnar component 104 relative to the humeral component 102, as described above.

The humeral component 102 and / or the ulnar component 104 may be made of one or more materials suitable for implantation within the human or animal body. These materials may include, without limitation, stainless steel, titanium, cobalt or one or more alloys thereof. In one example, the humeral component 102 may be titanium. In one example, the ulnar component 104 may be titanium. The ulnar head 132 of the ulnar component 104 may include a surface treatment that can improve the wear resistance of the ulnar head 132 as it articulates against the bearing surface. An example of such a surface treatment may include surface nitriding as described in the United States publication with serial number 2010/0051141.

Figures 4A-4E shows several views of the humeral component 102. Figure 4A is a front side view of the humeral component 102, and showing the humeral stem 118, the flange 120 and the fork 122 which includes the first 124 and the second 126 ears extending from the base 128 of the fork 122. The base 128 may include a sunken portion or hole 144 extending into the base 128.

Figure 4B is a side view of the humeral component 102. As shown in Figure 4B, the first ear 124 of the fork 122 may include an opening 146. In one example, the opening 146 may generally be an opening in V shape. In some examples, the V-shaped opening 146 can be configured for a specific coupling with pin 116, as described below. In other examples, any form suitable for opening 146 may be used. The second ear 126 may include a similar opening, which will be described in greater detail below.

Figure 4C is a view of a rear face of a humeral component 102. The humeral component 102 may include a hole or opening 148 in the base 128 of the fork 122, in the rear face and near the stem 118. The opening 148 may be used as an access hole for a surgical tool to help with the implantation of the elbow prosthesis 100 during surgery and / or during post implant surgery. The humeral component 102 may include a first hole 150 in the first ear 124 and a second hole 152 in the second ear 126. In one example, the first 150 and the second 152 holes may be threaded holes.

Figures 4D and 4E are perspective views of a portion of the humeral component 102 illustrating various features of the fork 122, including the features of the first 124 and the second 126 ears. Figures 4D and 4E generally show an exterior of the first ear 124 and an interior of the second ear 126. In one example, the first 124 and second 126 ears are substantially similar.

The second ear 126 may include an opening 154, similar to the opening 146 of the first ear 124. In one example, the opening 154 may be a generally V-shaped opening. The opening 154 may extend through the second ear 126 to form a generally V-shaped seat 156 in the second ear 126. The opening 154 may have any other shape, size or configuration to receive the pin 116.

As shown in Figures 4D and 4E, openings 146 and 154 may extend from an inner surface to an outer surface of the ears 124 and 126, respectively. In other examples, the openings 146 and 154 do not extend through the outer surfaces of the ears 124 and 126, depending, for example, on how the openings 146 and 154 are formed during the manufacture of the humeral component 102. The openings 146 and 154 can be formed to form V-shaped seats (seat 156) within the first 124 and the second 126 ears. A coupling of the pin 116 in the V-shaped seat 156 is described below.

The second ear 126 may include a cavity 158 formed in an upper portion of the second ear 126. The cavity 158 may include at least one surface contour characteristic 160A formed in the inner wall of the second ear 126. The characteristic 160A, which shown in Figure 4d, it can have any other shape, size or configuration to increase a distance between the two inner walls that form the cavity 158, so that the width between the inner walls can be greater than the width of an opening that defines the cavity 158. This difference in width between the inner walls and the opening of the cavity 158 can provide a snap fit when a tongue is inserted into one of the cubital bearings (see Figures 8A and 8B) inside the cavity 158. A surface contour feature 160B is shown in Figure 4E on a wall opposite feature 160A.

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The second ear 126 may include a second cavity 164 formed between the opening 154 and the cavity 158; The second cavity 164 may have any other shape, size or configuration to allow passage of one of the thymes (see Figure 5), as described below. The second ear 126 may include a first channel 162 formed through an interior of the second ear 126. The first channel 162 may have any other shape, size or configuration to receive an end portion of one of the fasteners and may be aligned with at least a portion of the second cavity 164. In one example, the areas of the cavities 158 and 164, and the opening 154 can generally form a continuous cavity in the second ear 126.

The fork 122 may include a seating surface 166 in the base 128 of the fork 122. The seating surface 166 may include the cavity 144 (see Figure 4A).

A cavity 167 may be formed in an upper portion of the first ear 124, similar to the cavity 158 of the second ear 126. The other corresponding features of the interior of the first ear 124 are not generally visible in Figures 4D and 4E; In one example, these corresponding characteristics of the first ear 124 may be substantially similar to those of the second ear 126.

Figure 2 is a perspective view of the second screw 114. In one example, the first screw 112 may be substantially similar to the second screw 114. The second screw 114 may include a threaded portion 168, a cylindrical (tapered) portion 169, a conical portion 170 and an end portion 172. In one example, as shown in Figure 5, the threaded portion 168 may have the thread externally. In certain examples, the threaded portion 168 may have the thread internally. The threaded portion 168 may have a larger diameter than the end portion 172. The cylindrical portion 169 and the conical portion 170 may be an unthreaded portion of the screw 114. The screw 114 may include an internal guide feature 174 allowing the use of a tool for fastening the screw 114 to another component, such as the second ear 126 of the fork 122. In certain examples, the screw 114 may include an external guide feature.

The first 112 and the second 114 screws can be made of one or more materials suitable for implantation within the human or animal body. These materials may include, without limitation, stainless steel, titanium, cobalt or one or more alloys thereof. In one example, the first 112 and the second 114 screws may be cobalt chrome.

Figure 6 is a perspective view of the pin 116, which may include a first end portion 176, a second end portion 178 and a main body portion 180. The first end portion 176 may include a first slot 177, a first outer diameter 181 and a first inner diameter 183. The second end portion 178 may include a second groove 179, a second outer diameter 185 and a second inner diameter 187. As shown in Figure 6, the main body portion 180 it may have a larger diameter than the internal diameters 183 and 187 and the external diameters 181 and 185 of the first 176 and the second 178 end portions.

The pin 116 can be made of one or more materials suitable for implantation within the human or animal body, and to allow the movement of rotation of one component relative to the other. These materials may include, without limitation, stainless steel, titanium, cobalt or one or more alloys thereof. In one example, pin 116 may be cobalt chrome.

Figure 7 is a perspective view of the humeral bearing 106, which may include an articulation surface 182, a first rail 184, a second rail 186, a seating surface 188 and a pin 190. The humeral bearing 106 can be coupled to the base 128 of the fork 122 of the humeral component 102, by inserting the pin 190 into the cavity 144 of the fork 122 (see Figure 4A) The connection between the humeral bearing 106 and the humeral component 102 is described later with references to Figures 11 and 12. Pin 190 may include a collar portion and a base portion 192.

The articulation surface 182 of the humeral bearing 106 may have any other shape, size or configuration such that the ulnar head 132 of the ulnar component 104 can articulate against the articular surface 182 when the ulnar component 104 rotates relative to the humeral component 102.

The humeral bearing 106 may include four ears 194; two ears 194 can be located at the corners formed between the seating surface 188 and the first rail 184, and two ears 194 can be formed at the corners formed between the seating surface 188 and the second rail 186. The ears 194 can facilitate an adjustment safe of the humeral bearing 106 on the base 128 of the fork 122, such as by means of a snap fit of the ears 194 on the base 128 of the fork 122, and can limit the movement of the humeral bearing 106, for example, when the forces are applied to the humeral bearing 106.

Figures 8A and 8B show two perspective views of the first ulnar bearing 108. Figure 8B shows the first ulnar bearing 108 rotated approximately 90 degrees relative to the view shown in Figure 8A. The first ulnar bearing 108 may include an outer face 196, a tongue 198, a groove 199, and shoulders 200 and 202 on each face of the tongue 198. The outer face 196 may be a seating surface between the first ulnar bearing 108 and the first ear 124 of the fork 122.

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The first ulnar bearing 108 may include a first opening or hole 204 to receive pin 116. In an example, the first hole 204 may include a bevel 206 to help guide pin 116 through first hole 204.

The first ulnar bearing 108 may include a first extension 208 having an articulation surface 210 and an end face 212. A second opening or hole 214 may extend through the end face 212 to receive the pin 116. In one example , the second hole 214 may include a bevel 216 to assist the pin 116 through the second hole 216. A compression flange 218 can extend from the end face 212 into at least a portion of the end face 212. The first 204 and second 214 holes can converge within the first ulnar bearing 108 to form a single single channel that is structured to allow passage of pin 116

In one example, the second ulnar bearing 110 may be substantially similar to the first ulnar bearing 108. When rotated by approximately 180 degrees relative to the position of Figure 8A, the second ulnar bearing 110 may coincide with the first ulnar bearing 108.

The humeral bearing 106 and / or the first 108 and the second 110 ulnar bearings can be made of one or more materials suitable for implantation within the human or animal body. In one example, the humeral bearing 106 and / or the first 106 and the second 108 cubital bearings 110, can be made of an elastomeric material, such as, for example, an ultra high molecular weight polyethylene (UHMWPE). In one example, the humeral bearing 106 may be formed by a crosslinked blend of ultra high molecular weight polyethylene stabilized with vitamin E, such as that described in US Patent No. 7,846,376. In one example, the first 108 and the second 110 ulnar bearings can be formed from a crosslinked blend of ultra high molecular weight polyethylene stabilized with vitamin E. When formed from an elastomeric material, bearings 106, 108 and 110 it can be tightened or compressed, for example, to overcome an interference fit or pressure fit, and / or form a metal shell component.

Figure 9 shows the elbow prosthesis 100 of Figures 1-3 in a partially assembled position. As shown in Figure 9, a bearing unit 230 may be assembled in the ulnar head 132 of the ulnar component 104. The bearing unit 230 may include the first ulnar bearing 108, the second ulnar bearing 110 and the pin 116. The first bearing extension 208 of the first ulnar bearing 18 (see Figure 8B) may extend into the opening 134 of the ulnar head 132. A second bearing extension in the second ulnar bearing 110 may extend into the opening 134 so that when the unit of bearing 230 is assembled in the ulnar head 132, the end face 212 of the first ulnar bearing 108 (see Figure 8B) may come into contact with the end face in the second ulnar bearing 110. The main body portion 180 of the pin 116 (see Figure 6) can extend through the first ulnar bearing 108, the ulnar head 132 and the second ulnar bearing 110; the first end portion 176 (see Figure 6) and the second end portion 178 of the pin 116 may remain exposed at this point in the assembly of the elbow prosthesis 100. When the first 108 and the second 110 ulnar bearings are assembled in pin 116, the end faces can come into contact with each other, in one example, a compression between each other of the first 108 and the second 110 ulnar bearings, can occur at a later stage when the bearings 108 and 110 and the ulnar component 104 can coupled to the humeral component 102.

A new stage in the assembly of the elbow prosthesis 100 may include connecting the ulnar component 104 to the humeral component 102, which may include placing the first end portion 176 of the pin 116 into the first ear 124 of the fork 122 and placing the second end portion 178 of the pin 116 in the second ear 126 of the fork 122. The pin 116 and the first 124 and second 126 ears of the fork 122 are each configured so that the first end portion 176 of the pin 116 can secured within the opening 146 formed in the first ear 124 and the second end portion 178 of the pin 116 can be secured within the opening 154 formed in the second ear 126.

As described above, the first 108 and the second 110 ulnar bearings can be formed of one or more elastomeric or compressible materials, so that the first 108 and the second 110 ulnar bearings can be tightened or compressed together as the bearing unit 230 and the ulnar component 104 are assembled into the humeral component 102. In one example, when the first 108 and the second 110 ulnar bearings are tightened together, the compression flange 218 in the first ulnar bearing 108 (see Figure 8B) can compressed against an end face of the second ulnar bearing 110, and a compression flange in the second ulnar bearing 110 can be compressed against the end face 212 of the first ulnar bearing 108 (see Figure 8B). In one example, the compression flanges can generally be semicircular so that when the end faces of the first 108 and second 110 ulnar bearings come into contact, the compression flanges form a generally circular shape with each other.

Once the ulnar bearing unit 230 is coupled to the humeral component 102, the first 108 and the second 110 ulnar bearings can be secured within the fork 122. In one example, the outer face 196 of the first ulnar bearing 108 (see Figure 8A) may come into contact with an inner surface 232 of the first ear 124,

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and an outer face 234 in the second ulnar bearing 110 may come into contact with an inner surface of the second ear 126. The tongue 198 in the first ulnar bearing (see Figure 8A) can be pressurized in the cavity 167 formed in the upper portion of the first ear 124; a tongue 236 in the second ulnar bearing 110 can snap into the cavity 158 formed in the upper portion of the second ear 126 (see Figure 4D). In one example, the tongue 198 in the first ulnar bearing 108 may be compressed during insertion of the tongue 198 into the cavity 167, until the tongue 198 passes through an opening of the cavity 167, at which point, the tongue 198 can relax and adapt to the space inside the cavity 167. As discussed above, the surface contour characteristics 160A and 160B formed in the interior walls of the cavities in the first 124 and second 126 ears, can facilitate pressure adjustment.

A next step in the assembly of the elbow prosthesis 100 may include inserting the first fastener 112 through the hole 150 of the first ear 124 and inserting the second fastener 114 through the opening 152 of the second ear 126. This is described further. forward with reference to Figure 10. Once the assembly is completed, the ulnar component 104 can rotate around the pin 116 to provide rotational movement of the ulnar component 104 relative to the humeral component 102. As the ulnar component 104 is moves, the ulnar head 132 can be articulated against the articulation surface 182 of the humeral bearing 106.

The elbow prosthesis assembly 100 can be configured so that the bearings 106, 108 and 110 or at least one characteristic of the bearings 106, 108 and 110 can be compressed during the assembly of the elbow prosthesis 100 and then relax and adapt to the surrounding area. Several characteristics of the bearings, such as the tabs described above, or the ears 194 in the humeral bearing 106, may allow adjustment by interference or pressure adjustment that may result in a stable placement of the bearings in the elbow prosthesis 100, for reduce or eliminate any movement of bearings 106, 108 and 110 inside elbow prosthesis 100, particularly as several forces or loads are placed in bearings 106, 108 and 110. In certain examples, alternatives or additional features may be used to those described herein, in bearings 106, 108, 110 to provide a snap fit.

Figure 10A is a side view of a portion of the elbow prosthesis 100 as assembled, and shows the second ear 126 of the humeral component 102 and a portion of the ulnar component 104, including the ulnar neck 131 and a portion of the stem 130 As shown in Figure 10A, the second end portion 178 of the pin 116 may be seated inside the opening 154 formed in the second ear 126. In one example, the opening 154 may generally be V-shaped and the portion end 178 of pin 116 may have at least two contact points C1 and C2 with a seat 156 formed by opening 154. Seat 156 can be sized, shaped or configured to hold pin 116 in a desired position and limit or resist the movement of the pin 116. The first end portion 176 of the pin 116 may similarly seat inside the opening 146 formed in the first ear 124. The position of the pin 116 e n opening 154 is described below with reference to Figures 10C and 10D. The same description generally applies to the position of the pin 116 in the opening 146. As described above with reference to Figures 4D and 4E, the openings 146 and 154 may extend, in some examples, through an outer part of the ears. 124 and 126. The openings 146 and 154 can be configured to create V-shaped seats inside the ears 124 and 126 to engage with the pin 116.

Figure 10B is a perspective view of an assembled elbow prosthesis 100 of Figure 10A with a portion of the second ear 126 of the humeral component 102 cut to show various components in and around the second ear 126. In addition to the second ear 126, Figure 10B shows the second end portion 178 of the pin 116, the screw 114 and the second ulnar bearing 110, the ulnar head 132, the first ulnar bearing 108 and the first ear 124. The second screw 114 can extend into the second ear 126. In one example, the second screw 114 may extend into the second ear 126 at an angle in the posterior anterior direction. The threaded portion 168 of the screw 114 can engage with the threaded hole 152 in the second ear 126. The non-threaded or conical portion 170 can be coupled with the second end 178 of the pin 116. The conical portion 170 can be coupled with the groove 179 (Figure 6) of pin 116 between inner diameter 187 and outer 185 of end portion 178. End portion 172 of screw 114 can be received in channel 162 formed in the second ear.

As shown in Figure 10B and described above with reference to the tongue 198, the tongue 236 in the second ulnar bearing 110, can have a snap fit in the cavity 158 of the second ear 126 to secure the second ulnar bearing 110 to the second ear 126 and minimize or resist the movement of the second ulnar bearing 110.

Figure 10C is a cross-sectional view of elbow prosthesis 100 taken along line 10C-10C in Figure 10A. Figure 10C shows a coupling between the second end portion 178 of the pin 116 and the conical portion 170 of the second screw 114, as well as a coupling between the first end portion 176 of the pin 116 and the first screw 112. The coupling between the second screw 114 and the pin 116 are described in greater detail herein with reference to Figures 10C and 10D; The coupling between the first screw 112 and the pin 116 can be substantially similar. The contact areas C8 and C9 shown in Figure 10C are described below with reference to Figure 13B.

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When the elbow prosthesis 100 is implanted in a patient's elbow, the prosthesis can be subjected to various anatomical forces or loads, which includes an internal / external rotational force F1, a varus load F2 and a valgus load F3. A compressive joint load, which can occur in a general direction represented as a vector V3 in Figure 10C, can be one of the highest forces in the prosthesis 100 and can also be referred to as an anatomical load. The design of the screw 114 and the pin 116 and its placement in the humeral component 102 can be configured to avoid or minimize exposure to cyclic transverse loads / discharges and / or reverse loads and to minimize or resist the discharge of any of the components, in particular screw 114, even under varying forces and the high compression joint load described above. As described in more detail below, screw 114 and pin 116 can be configured to minimize or resist the loss of screw 114 over time, compared to other prosthetic designs in which the screw can be loosened. A specific coupling of the screw 114 with the pin 116 can be used to hold the pin 116 in place, even under high compression joint loads. As described in more detail below, screw 114 and pin 116 can resist micro movement in at least one direction.

The conical portion 170 of the screw 114 (Figure 10B) may be received in the groove 179 formed in the second end portion 178 of the pin 116. In one example, the conical portion 170 of the screw 114 may have at least two contact points C3 and C4 with the pin 116, such contact points can generally be centered around the groove 179 in the pin 116. (A plane in the center of the groove 179 is shown in Figure 10C as the PL1) The screw 114 can serve as a wedge to retain the pin 116 within the second ear 126 and minimize or resist the movement of the pin 116 when the pin 116 is exposed to the various forces and loads. The contact points C3 and C4 between pin 116 and screw 114 can help retain pin 116 to minimize movement of pin 116 from side to side, especially when the prosthesis is exposed to the varied forces described above and shown in Figure 10C, and can help minimize or resist micro movement in a direction indicated by M2 in Figure 10C.

As described above with reference to Figure 10A, the end portion of the pin 178 may have at least two contact points C1 and C2 with the seat 156 In one example, the end portion 178 of the pin 116 may have four points of contact with the seat 156. The contact point C1 may be in the outer diameter 185 (Figure 6) of the end portion 178 and another contact point C5 may be in the inner diameter 187 (Figure 6) of the end portion 178. The contact point C2 may similarly be located at the contact point C1, and therefore not visible in Figures 10A or 10C, another contact point that can be similarly located at the contact point C5, may be in the internal diameter 187 of the end portion 178, adjacent to the contact point C2. These contact points of the pin 116 in the seat 156, added to the coupling of the screw 114 and the pin 116, can minimize or resist micro movement in the direction indicated by M1 in Figure 10C.

As the screw 114 is inserted into the hole 52 (Figure 10B), the screw 114 can be directed towards the groove 179 in the pin 116 which can move the second end portion 178 of the pin 116 into the seat 156 of the ear 126 of humeral component 102 (Figure 10A). However, pin 116 can move up and down or flex in response to the forces therein, including the high compression joint load, shown as vector V3 in Figure 10C. A profile P2 in Figure 10C represents a profile of the pin 116 when it is under a high articulation load The pin 116 can thus flex back and forth, and as a result of the bending action, the second end 178 of the pin 116 can move and push on screw 114 in a reactive load direction, represented by a vector V2 in Figure 10C. (A profile of screw 114 when subjected to a maximum reactive load can be represented as a profile P1 in Figure 10C) Screw 114 can be tightened until the prescribed screw torque is reached, which can ensure that all meeting surfaces of the components are compressed together. As described above, screw 114 may have several points of contact with pin 116 - so screw 114 can be supported by pin 116 while reaching the prescribed screw torque, which may allow screw 114 to bend elastically from the pin 116 while screw 114 is directed inward.

The elastic flexion of the screw 114 can generate a force in a direction represented by a vector V1 in Figure 10C - the force is a clamping load created by the tightening of the screw 114. The clamping load can counteract the reactive load created by the pin 116 (the direction of the reactive load is represented as vector V2). The clamping load by screw 114 can secure pin 116 against seat 156.

As the screw 114 is tightened and flexed, the screw 114 can exert a force on the pin 116. During an operating life of the prosthesis 100, there may be wear that can cause the screw 114 to gradually rebound towards a non-curved shape. ; however, even then, screw 114 can continue to apply a compression load on pin 116 to resist micro movement. Although the holding load may decrease over time, a residual holding load over the life of the prosthesis 100 can be maintained at several points of contact between the pin 116 and the screw 114, and the pin 116 in the seat 156. This load Residual clamping can provide long-term resistance to loosening screw 114 and / or resistance to micro movements mentioned above.

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As shown in Figure 10D, Figure 10C shows the cylindrical portion 169 of the thyme 114 having a contact point C6 with an inner portion of the ear 126 of the humeral component 102.

Figure 10D is a rear view of the portion of the elbow prosthesis 100 shown in Figure 10B. The profile P1 of the screw 114 under a maximum reactive box can be seen in Figure 10D. Moreover, Figure 10D shows many of the contact points shown in Figure 10C and described above. In addition to the contact point C6, the screw 114 may have at least one other contact point C7 with the inner ear portion 126 of the humeral component 102. As shown in Figure 10D, in an example, the end portion 172 of the screw 114 may have a contact point C7 with the humeral component 102. Additionally, the pin 116 has the four contact points with the opening 154 in the ear 126, as described with reference to Figure 10C. As indicated above, these contact points can help minimize discharge and / or minimize or resist micro movement in at least the direction indicated by M1 in Figure 10C.

Figure 11 is a cross-sectional view of a portion of the humeral component 102 and the humeral bearing 106, before securing or attaching the humeral bearing 106 to the humeral component 102. Specifically, Figure 11 shows the base 128 of the fork 122, including the seating surface 166 and the cavity 144 and a portion of the rod 118 and the flange 120 of the humeral component 102. The humeral bearing 106 may be configured to engage the base 128 of the fork 122. As described above with reference to the Figure 7, the humeral bearing 106 may include the seating surface 188 and the pin 190. The pin 190 may have a generally circular shape and the collar portion 191 of the pin 190 may have a diameter larger than a base portion 192 .

In one example, the cavity 144 in the base 128 may have a generally circular shaped cavity. In certain examples, cavity 144 may have a non-circular shape and pin 190 may have a non-circular shape.

Figure 12 shows the humeral component 102 and the humeral bearing 106 when the humeral bearing 106 is secured to the humeral component 102, by means of the pin 190 in the cavity 144.

In one example, the pin 190 can be inserted into the cavity 144 by applying a force to the humeral bearing 106, by using a blunt tool that comes into contact with the articulation surface 182 of the humeral bearing 106. The force can applied until pin 190 is compressed and tightened through an opening in cavity 144. Once the collar portion 191 passes through the opening, the collar portion 191 can relax or extend into the cavity 144. Figure 12 shows at least one interference 11 and 12 between the collar portion 191 and the walls that form the cavity 144. The pin 190 can overcome this generally circular interference, by compression of the collar portion 191 as described above. This type of pressure adjustment can facilitate safe coupling of the humeral bearing 106 to the humeral component 102 and can limit or resist the movement of the humeral bearing 106.

At least one cut 189 may be included in the seating surface 188 of the humeral component 106 so that the seating surfaces 166 and 188 of the base 128 of the humeral component and the humeral bearing 106, respectively, can come into contact with each other.

Figure 13A shows the elbow prosthesis 100 in an assembled position and includes the humeral component 102 having the first 124 and the second 126 ears, and the ulnar component 104 having the ulnar head 132 shown between the first 108 and the second 110 ulnar bearings.

Figure 13B is a cross-sectional view of elbow prosthesis 100 taken along line 13B-13B in Figure 13A. Figure 13B shows a coupling of the ulnar head 132 with the humeral bearing 106 and a coupling of the ulnar head 132 with the first ulnar bearing 108. While the ulnar head 132 articulates, an outer surface of the ulnar head 132 may come into contact. with the articulation surface 182 of the humeral bearing 106 in a contact area represented by C8 in Figure 13B. Over time, surfaces may begin to wear out; however, because the humeral bearing 106 can remain substantially stationary, the ulnar head 132 can articulate through the articulation surface 182 and wear can spread through a larger area, including the contact area C8.

As described above, the first 108 and the second 110 ulnar bearings are snapped into the pin 116. Thus the ulnar bearings 108 and 110 are substantially stationary within the elbow prosthesis 100. While the ulnar head 132 articulates, a inner surface of the ulnar head 132 may come into contact with an outer surface of the first ulnar bearing 108 in an area represented by C9 in Figure 13B. As described similarly above, with reference to the articulation surface 182 of the humeral bearing 106, wear through the first ulnar bearing 108 can be spread over a larger area, including the contact area C9.

The first ulnar bearing 108 can be configured such that the opening 214 in the ulnar bearing 108 moves from an axis of the bearing extension 208 (Figure 8B) of the ulnar bearing 108. Similarly, Figure 13B shows an axis of bearing A1 and a pin axis A2, which can move each other by

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a distance D3. A lower region 111 of the first ulnar bearing 108 may occupy less space between the bearing extension 208 and the opening 214, while comparing with an upper region 109 of the first ulnar bearing 108 - this is shown in Figure 13B for a distance D1 in the upper region 109 which is larger than a distance D2 in the lower region 111. This displacement can maximize a material thickness between the bearing extension 208 and the opening 214 in a region of the prosthesis that can withstand high and common loads during the life of the prosthesis 100. In addition, the anatomical load or compression joint load V3 can be shared by a simultaneous contact represented by the contact area C8 between the ulnar head 132 and the humeral bearing 108 and the contact area C9 between the ulnar head 132 and the ulnar bearing 108, thus, extends the life of the prosthesis 100 by means of helping to reduce the wear of the r odamiento.

The elbow prosthesis 100 can be configured to include multiple components and features that, alone or together, contribute to a stability of the elbow prosthesis during the life of the prosthesis within the patient's body. Various bearings can work together with the fasteners and the pin to provide a stable coupling of the ulnar component to the humeral component. The configuration of the bearings can limit or resist the micro movement of the bearings inside the elbow prosthesis 100. The bearings can work together with the fasteners and the pin of the elbow prosthesis to limit or resist loosening the fasteners. Multiple contact points of the fastener and pin, with each other and with other parts of the elbow prosthesis, can result in a stable design. The configuration of bearings that are substantially fixed or stationary relative to the articulated ulnar head of the ulnar component can minimize wear on the bearing joint surfaces.

Figure 14 illustrates a method 300 of repairing a patient's elbow joint, through the use of a prosthesis, such as an elbow prosthesis as described herein. The elbow prosthesis may include an ulnar component and a humeral component. In 302, a user can insert a cubital stem of the ulnar component into a cubital medullary canal of the patient. An ulnar head connected to the ulnar stem may remain exposed outside the ulnar medullary canal. In 304, the user can assemble a bearing unit in the ulnar head. The bearing unit may include a first ulnar bearing, a second ulnar bearing and an extendable pin through the first ulnar bearing, the second ulnar bearing and the ulnar head. In 306, the user can insert a humeral stem of the humeral component into a humeral medullary canal. A fork connected to the humeral stem can remain exposed outside the humeral medullary canal. The fork may include the first and second ears that extend from a fork base.

In 308, a user can connect the ulnar component to the humeral component. In one example, 308 may include placing a first end portion of the bearing unit pin in an opening in the first ear of the fork, and placing a second end portion of the pin in an opening in the second ear of the fork . Connecting the ulnar and humeral components can allow the ulnar component to rotate relative to the humeral component. In 310, a user can secure the ulnar component to the humeral component. In one example, 310 may include threading a first fastener on the first ear of the fork and a second fastener on the second ear of the fork. A portion of the first fastener can be coupled with the first end portion of the pin and a portion of the second fastener can be coupled with a second end portion of the pin.

In one example, 310 may include securing the first ulnar bearing to the first ear of the fork and securing the second ulnar bearing to the second ear of the fork. The first ulnar bearing may include an insert tab in a cavity in the first ear of the fork. The second ulnar bearing may include an insert tab in a cavity in the second ear of the fork.

In one example, method 300 may include ensuring a humeral bearing at the base of the fork, before connecting the ulnar component to the humeral component. The humeral bearing may include a structured articulation surface to allow articulation of the ulnar head relative to the humeral component.

In certain examples, at least some steps of the methods 300 may be performed in a different order than described above. In certain examples, one or more tools may be used in several steps in method 300 to assist with an assembly of the elbow prosthesis and / or an implantation of the elbow prosthesis in the patient's body. In one example, a tool can be used to assemble the bearing unit in the ulnar head of the ulnar component. Reference is made to a co-pending United States application, filed on March 13, 2013, with United States serial number 13 / 800,650, (attorney file number 4394.563US1), entitled "ASSEMBLY TOOL FOR A PROSTHETICS", and directed to an assembly tool configured to assemble the bearing unit in the ulnar component. In one example, a tool can be used to secure the humeral bearing at the base of the fork.

Although specific configurations of an elbow prosthesis are shown in the figures particularly described above, other designs of an elbow prosthesis can be used. For example, the elbow prosthesis can also be customized for a patient (for example, provide with at least one component patient specific).

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The elbow prosthesis 100 may be provided together with an assembly tool such as, for example, a user may have easy access to the assembly tool during an implantation procedure for the elbow prosthesis 100. In one example, a system and / or a repair assembly of a patient's elbow joint, may include the elbow prosthesis 100 and an assembly tool. In one example, the assembly may include a plurality of prostheses of various sizes and / or a plurality of components of various sizes. The assembly may include instructions for using the assembly tool. In one example, the elbow prosthesis 100 and the assembly tool can be provided separately to the user, but used in combination during the implantation procedure. The assembly tool can be reused in a subsequent implantation procedure after undergoing sterilization.

The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific modalities in which the invention can be practiced. In this document, the terms "a" or "a" are used, as is common in patent documents, to include one or more than one, independent of any other instance or uses of "at least one" or "one or more.In this document, the term "or" is used to refer to a term "or" not exclusive, such as "A or B" includes "A but not B," "B, but not A," and " A and B, "unless stated otherwise. In this document, the terms" include "and" in which "are used as the equivalent of plain English of the respective terms" comprising "and" where. " , in the following claims, the terms "include" and "comprising" are open-ended, which is a system, device, article, composition, formulation, or process that includes elements in addition to those listings after such a term. in a claim they are still considered to fall within the scope of that claim. Moreover, in the following rei vindications, the terms "first," "second," and "third," etc. they are used merely as labels, and are not intended to impose numerical requirements on their objects.

The above description is intended to be illustrative, and not restrictive.

Claims (14)

5 10 fifteen twenty 25 30 35 40 Four. Five fifty 55 60 65 Claims 1. A prosthesis for elbows (100) comprising: a humeral component (102) comprising a humeral stem (118) and a fork (122) having a first and second ears (124, 126) extending from a base (128) of the fork (122); a humeral bearing (106) positionable at the base (128) of the fork (122): a ulnar component (104) comprising an ulnar stem (130) and an ulnar head (132); a first ulnar bearing (108) positionable between the first ear (124) of the fork (122) and the head ulnar (132); a second ulnar bearing (110) positionable between the second ear (126) of the fork (122) and the ulnar head (132); a pin (116) having a first end portion (176) and a second end portion (178) and is configured to extend through the ulnar head (132), the first ulnar bearing (108) and the second bearing cubital (110), wherein the first end portion (176) of the pin (116) is configured to extend into the first ear (124) of the fork (122) and the second end portion (178) of the pin (116) ) is configured to extend into the second ear (126) of the fork (122), and where the ulnar component (104) is configured to rotate around the pin (116) to allow movement of the ulnar components (104) configured to rotate around the pin (116) to allow movement of the ulnar component (104) relative to the humeral component (102): a first fastener (112) that is inserted through at least a portion of the first ear (124) of the fork (122) to engage with the first end portion (176) of the pin (116); Y a second fastener (114) that is inserted through at least a portion of the second ear (126) of the fork (122) to engage with the second end portion (178) of the pin (116). 2. The elbow prosthesis of claim 1 wherein the first end portion (176) of the pin (116) is configured to extend into a first opening (146) in the first ear (124) of the fork (122) and The second end portion (178) of the pin (116) is configured to extend into a second opening (154) in the second ear (126) of the fork (122). 3. The elbow prosthesis of claim 2 wherein the first and second openings (146, 154) are generally V-shaped and the first and second portions (176, 178) of the pin (116) must each have the minus two points of contact with the first and second openings (146, | 54) respectively. 4. The elbow prosthesis of claim 1 wherein the first fastener is a first screw (112) having a threaded portion (168), a conical portion (170) and an end portion (172) and the second fastener is a second screw (114) having a threaded portion, a conical portion and an end portion. 5. The elbow prosthesis of claim 4 wherein the first ear (124) of the fork (122) includes a first threaded hole (150) for coupling with the threaded portion (168) of the first screw (112), and the Second ear (126) of the fork (122) includes a second threaded hole (152) to engage with the threaded portion of the second screw (114). 6. The elbow prosthesis of claim 4 wherein the fork (122) of the humeral component (102) includes a first channel (162) formed in the first ear (124) to receive the end portion (172) of the first screw (112) and a second channel (162) formed in the second ear (126) to receive the end portion of the second screw (114). 7. The elbow prosthesis of claim 4 wherein the conical portion (170) of the first screw (112) is coupled with a first groove (177) in the first end portion (176) of the pin (116) and the portion Conical of the second screw (114) is coupled with a second groove (179) in the second end portion (178) of the pin (116). 8. The elbow prosthesis of claim 1 wherein the humeral bearing (106) is configured such that the ulnar head (132) articulates against a surface (182) of the humeral bearing (106) when the ulnar component (104) rotates in relation to the humeral component (102). 9. The elbow prosthesis of claim 1 wherein the first ulnar bearing (108) includes a first bearing extension (208) configured to extend into an opening (134) in the ulnar head (132) and the second ulnar bearing ( 110) includes a second bearing extension configured to extend into the opening (134) in the ulnar head (132), and wherein an end face (212) of the first bearing extension (208) is positioned adjacent to a face end of the second bearing extension. 10. The elbow prosthesis of claim 9 wherein a first opening (214) in the first ulnar bearing (108) is displaced from an axis of the first bearing extension (208) and a second opening in the second ulnar bearing ( 110) moves from an axis of the second bearing extension. 10 fifteen 11. The elbow prosthesis of claim 9 wherein the first bearing extension (208) is configured such that an inner surface of the ulnar head (132) articulates against a surface (210) of the first bearing extension (208) and the second bearing extension is configured such that an inner surface of the ulnar head (132) articulates against a surface of the second bearing extension. 12. The elbow prosthesis of claim 1 wherein an outer face (196) of the first ulnar bearing (108) is configured to come into contact with the first ear (124) of the fork (122) and an outer face (234 ) of the second ulnar bearing (110) is configured to come into contact with the second ear (126) of the fork (122). 13. The elbow prosthesis of claim 12 wherein the first ulnar bearing (108) comprises a first tongue (198) extending from the outer face (196) and is configured to snap into a cavity (167) in the first ear (124) of the fork (122), and a second ulnar bearing (110) comprising a second tongue (236) that extends from the outer face (234) and is configured to pressure fit a cavity ( 158) on the second ear (126) of the fork (122). 14. The elbow prosthesis of claim 1 wherein the humeral bearing (106) includes a pin (190) extending from a lower surface of the humeral bearing (106), the pin (190) is configured for an adjustment coupling under pressure with a cavity (144) in the base (128) of the fork (122). twenty